It may not be quite as revealing as the Sports Illustrated swimsuit issue. Or as heavily mathematical as the Dow Jones Industrial Average. But the members of the 2009 ClinPage Master Providers list do have a few qualities in common. We're announcing the list today, and will have two additional stories.

In aggregate, the dozen companies on our list employ 65,828 people and reported $9.4 billion in 2008 revenues. All but one have their headquarters located inside a triangle of the eastern United States measuring roughly 750 miles on each side as the crow flies.

Bounded by Cincinnati on the west, Wilmington, North Carolina to the south and Boston to the east, the headquarters of these firms are located within a short flight of each other. They are all based within driving distance of Philadelphia, the unofficial capital of the pharmaceutical industry, where the sole firm on our list headquartered outside the U.S. has a presence.

Gap Analysis

Many of the companies on our list are located near each other, in pairs or triplets. This is not surprising: executives from one top firm may decamp to start a rival, and trust that a few talented workers may be found nearby.


One surprising aspect to our list is that there are no firms from California. Before we are deluged with complaints, we hasten to add that there are many small, esteemed clinical trial firms in California.

But the absence of large, dominant firms from that state could be a reflection on the cultural conditions necessary for excellence in industry-sponsored clinical research. The companies on our list have old-fashioned ideas about basing their businesses on selling services and products. Such ideas are not in vogue in California.

The financial community there, particularly in San Francisco, disdains old-school concepts like ... revenues and customers. Instead, top venture capitalists there gauge a company's prospects by two criteria. Can it 1) trigger delirium among the news media (think Facebook, Myspace, Flickr, YouTube or Twitter) and 2) be purchased by Google, Yahoo, Time-Warner or some other lumbering bureaucracy? Thankfully, new age California methods to incubate zero-revenue businesses have only spread a short distance, to biotechnology and green energy firms.

Being Gravity

At the same time, it's easy to predict that the California of the future might be a competitive and auspicious place from which to launch a large company supporting clinical trials. The proximity to Asia and a well-trained scientific workforce would be just two of the many attractions.


The ClinPage Master Providers share a doubly heavy burden of honoring country-by-country regulation and global scientific guidelines. As a result, the companies on our list are cautious and sober in temperament. Their responsibilities to sick patients and their families, not to mention government regulators, impart a gravity and seriousness to their work that is common throughout the clinical trial community at firms of any size.

Another hallmark of the ClinPage Master Provider list is that the companies on it are prospering, not reeling, from globalization. Although larger numbers of clinical trials are finding both patients and investigators overseas, the day-to-day operational aspects of the biggest trials tend to be be run in the U.S. and western Europe by the firms on our list.

Our firms have special expertise in larger trials that are beyond the abilities of the academic community. The academic community's deep medical expertise, of course, is a valued aspect and crucial element of the industry's success. The proximity of the companies on our list to major academic medical centers is no accident.

Financial Strength

To varying degrees, all the companies on our list knit together technology and services in ways that are difficult for outsiders to understand, much less replicate. As such, the barriers to entry in the top tier of the clinical trial services landscape are Himalayan in height. And the usage of technology in clinical trials, while still resisted in some quarters, is one of the few viable ways that the paper-loving pharmaceutical industry may be able to reduce costs, time lines or both in the years ahead.


In an economy that is as ominous as any in the past 70 years, the ClinPage Master Providers are prosperous. The median growth in revenue from 2007 to 2008 was 26 percent. The median growth in profits, when we could obtain such data, was 20 percent. Not shabby. Some of the firms on our list are still hiring. The median head count of the companies on our list is above 3,000. d9A2t49mkex

With huge industries such as insurance, real estate, banking, and automobiles now having collapsed, the companies on our list are different. Rather than design "investments" that require vast governmental cleanup operations, these scientifically-oriented companies help their customers develop boring, practical things—drugs to vanquish HIV, swine flu or the dark moods of a new mom. The companies on our list are well-managed and adequately capitalized. They have large backlogs of orders that will help them to weather the downturn and out-muscle smaller competitors. They pay their workers enough to support their families.

Beyond 2009

All this does not mean the ClinPage list members won't have difficulties, or that their futures are guaranteed. Far from it. These companies too will be affected by the global downturn. Their relationships with key customers could be abruptly damaged by a single hiccup in a single trial—or a single botched database.

Collectively, the firms on our list will also be affected by expiring patents and shrinking R&D budgets in the sponsor community. Indeed, late in 2008, pharmaceutical and biotechnology industries started to focus more intensively on their most promising projects, and to scale back preclinical and early human testing. How long such dynamics will remain in place is decidedly murky. It might last another year or another decade.

Fortunately, the steady growth of clinical research over the long, long term suggests that the troubles of the firms on our list may not be as deep as those experienced by most of the rest of the global economy.

This article discusses the individual companies on our list in detail. This article discusses our methodology. Readers with questions or comments about the list are encouraged to contact .(JavaScript must be enabled to view this email address)